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  MIG Update – June 22, 2026

How Static Medical Opinions Led to a $30K MIG Escape

This week’s MIG review involves a case where the Tribunal was tasked with reconciling whether an Applicant’s lingering pain complaints and driving anxieties constituted minor injuries, or if they represented a documented, long-term functional decline. Can an insurer safely rely on historical IE’s when the claimant’s post-IE medical record shows ongoing deterioration?

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In Joshi v. Belair (24-010548) Ujjwal Joshi was involved in an accident on January 25, 2022, and sought entitlement to six Treatment Plans for psychological, chiropractic, and massage therapy services, a chronic pain assessment, and a multidisciplinary chronic pain management program, totaling $30,593.78. He sought to be removed from the MIG based on a psychological impairment.

To resolve this dispute, the Tribunal had to weigh a heavily documented, 3-year history to Belair’s early, static examinations against Joshi’s evolving clinical record:

The Evidence:

• • June 2022 (Belair IEs): Dr. Syed (Psychologist) rules out a DSM-5 diagnosis due to a lack of objective evidence. Dr. Belfon (Orthopaedic) concludes injuries are limited to minor soft-tissue sprains/strains.
  • January 2023 (Joshi’s Evidence): Dr. Pilowsky (Psychologist) diagnoses Somatic Symptom Disorder, secondary depression, PTSD, and driving phobia, noting significant social and workplace functional loss.
  • February 2023 (Joshi’s Evidence): Dr. Ogilvie-Harris (Orthopaedic Surgeon) diagnoses Chronic Pain Syndrome with central sensitization. Objective Pain Disability Questionnaire scores indicate severe physical (67/90) and psychological (38/60) disability.
  • March/April 2023 (Belair Follow-up IEs): Dr. Syed maintains no psychological impairment exists. Dr. Nesterenko (Orthopaedic) deems injuries minor and denies the need for a chronic pain assessment, notably failing to address workplace functional limitations.
  • September 2023 – December 2024 (Joshi’s Updates): Dr. Nguyen (Psychologist) documents severe flashbacks and structural changes to daily living. Family doctor CNRs show 20+ months of consistent complaints, Cymbalta prescriptions, and a final 2024 medical report confirming long-term treatment for PTSD and anxiety.

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  The Tribunal found:
  

  • • Joshi was removed from the MIG on a finding of psychological impairment. The contemporaneous family doctor CNRs and psychologist reports consistently documented functional decline including flashbacks, anxiety when driving, social withdrawal, work absenteeism, mood symptoms, and avoidance of leaving the house, for which he was prescribed Cymbalta. It preferred this 20-month continuous treatment record over Belair’s IEs, which failed to account for Joshi’s worsening post-assessment condition.
    • Joshi was entitled to $9,005.19 for the three chiropractic and massage therapy services Treatment Plans. The family doctor’s CNRs consistently documented objective, ongoing bilateral scapular and paraspinal pain. This was reinforced by Dr. Ogilvie-Harris’s finding of severe mobility restrictions, creating an unbroken chain of medical necessity.
    • The documented physical and psychological complaints to his treatment providers and family doctors confirmed the need for the chronic pain assessment. The IE by Dr. Nesterenko completely failed to consider Joshi’s self-reported pain, functional restrictions, or his documented need for assistance at work.
    • The $15,322.73 for the multidisciplinary chronic pain management program was backed by objective testing via the Pain Disability Questionnaire in Dr. Ogilvie-Harris’s February 2023 report. Belair failed to send this report back to its own assessors for a rebuttal opinion, leaving the denial completely unclarified and without competing medical evidence at the hearing.

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